肝脏影像报告和数据系统 2018 版第 5 类诊断肝细胞癌：一项更新的荟萃分析。
Liver Imaging Reporting and Data System version 2018 category 5 for diagnosing hepatocellular carcinoma: an updated meta-analysis.
机构信息
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
Eur Radiol. 2024 Mar;34(3):1502-1514. doi: 10.1007/s00330-023-10134-z. Epub 2023 Sep 1.
OBJECTIVE
We performed an updated meta-analysis to determine the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS, LR) 5 category for hepatocellular carcinoma (HCC) using LI-RADS version 2018 (v2018), and to evaluate differences by imaging modalities and type of MRI contrast material.
METHODS
The MEDLINE and Embase databases were searched for studies reporting the performance of LR-5 using v2018 for diagnosing HCC. A bivariate random-effects model was used to calculate the pooled per-observation sensitivity and specificity. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material.
RESULTS
Forty-eight studies qualified for the meta-analysis, comprising 9031 patients, 10,547 observations, and 7216 HCCs. The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC were 66% (95% CI, 61-70%) and 91% (95% CI, 89-93%), respectively. In the subgroup analysis, MRI with extracellular agent (ECA-MRI) showed significantly higher pooled sensitivity (77% [95% CI, 70-82%]) than CT (66% [95% CI, 58-73%]; p = 0.023) or MRI with gadoxetate (Gx-MRI) (65% [95% CI, 60-70%]; p = 0.001), but there was no significant difference between ECA-MRI and MRI with gadobenate (gadobenate-MRI) (73% [95% CI, 61-82%]; p = 0.495). Pooled specificities were 88% (95% CI, 80-93%) for CT, 92% (95% CI, 86-95%) for ECA-MRI, 93% (95% CI, 91-95%) for Gx-MRI, and 91% (95% CI, 84-95%) for gadobenate-MRI without significant differences (p = 0.084-0.803).
CONCLUSIONS
LI-RADS v2018 LR-5 provides high specificity for HCC diagnosis regardless of modality or contrast material, while ECA-MRI showed higher sensitivity than CT or Gx-MRI.
CLINICAL RELEVANCE STATEMENT
Refinement of the criteria for improving sensitivity while maintaining high specificity of LR-5 for HCC diagnosis may be an essential future direction.
KEY POINTS
• The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC using LI-RADSv2018 were 66% and 91%, respectively. • ECA-MRI showed higher sensitivity than CT (77% vs 66%, p = 0.023) or Gx-MRI (77% vs 65%, p = 0.001). • LI-RADS v2018 LR-5 provides high specificity (88-93%) for HCC diagnosis regardless of modality or contrast material type.
目的
我们使用 LI-RADS 版本 2018（v2018）进行了更新的荟萃分析，以确定用于肝细胞癌（HCC）的 Liver Imaging Reporting and Data System（LI-RADS，LR）5 类别在诊断性能，并且评估不同成像方式和类型的 MRI 对比剂的差异。
方法
在 MEDLINE 和 Embase 数据库中搜索使用 v2018 报告 LR-5 用于诊断 HCC 的性能的研究。使用双变量随机效应模型计算汇总观察敏感性和特异性。根据成像方式和 MRI 对比剂类型进行亚组分析。
结果
有 48 项研究符合荟萃分析的条件，包括 9031 名患者，10547 次观察和 7216 个 HCC。LR-5 用于诊断 HCC 的汇总观察敏感性和特异性分别为 66%（95%CI，61-70%）和 91%（95%CI，89-93%）。在亚组分析中，细胞外试剂（ECA-MRI）的 MRI 显示出明显高于 CT（77%[95%CI，70-82%]；p=0.023）或钆塞酸（Gd-EOB-DTPA）MRI（65%[95%CI，60-70%]；p=0.001）的汇总敏感性，但 ECA-MRI 与钆贝葡胺（gadobenate-MRI）（73%[95%CI，61-82%]；p=0.495）之间没有显著差异。CT 的汇总特异性为 88%（95%CI，80-93%），ECA-MRI 为 92%（95%CI，86-95%），Gd-EOB-DTPA MRI 为 93%（95%CI，91-95%），gadobenate-MRI 为 91%（95%CI，84-95%），无显著差异（p=0.084-0.803）。
结论
LI-RADS v2018 LR-5 为 HCC 诊断提供了较高的特异性，而不管成像方式或对比剂类型如何，而 ECA-MRI 的敏感性高于 CT 或 Gd-EOB-DTPA MRI。
临床相关性
改善敏感性的同时保持 LR-5 对 HCC 诊断的高特异性可能是未来的重要方向。
要点
• 使用 LI-RADSv2018 诊断 HCC 的 LR-5 的汇总观察敏感性和特异性分别为 66%和 91%。• ECA-MRI 的敏感性高于 CT（77%比 66%，p=0.023）或 Gd-EOB-DTPA MRI（77%比 65%，p=0.001）。• 无论成像方式或 MRI 对比剂类型如何，LI-RADS v2018 LR-5 对 HCC 诊断均具有较高的特异性（88-93%）。
Zotero 插件